I have been away from my office for nearly two weeks, but it has been worth it. I have had the great pleasure of being one of only a few practitioners in an Acupuncture for Sports Medicine Apprenticeship Program. One of the few Americans leading the way in the field of Chinese Sports Medicine, Whitfield Reaves, has designed this apprenticeship to share the vast knowledge he has gained over his 30 years of treating Olympic athletes. On the gorgeous Hawaiian island of Maui I have been absorbing as much as I can about treating sports injuries and enhancing athletic performance. I have treated many athletes over the years at Queen Anne Acupuncture, including marathoners, tri-athletes, snowboarders, soccer players, yoga instructors, circus performers and even a competitive fencer. I have had success with most of these patients, but I am always looking to improve my treatments and the speed with which my patients heal from injuries so they can get back to the activities they love. I have confidence that the needle techniques and the refinement of my knowledge of anatomy during this apprenticeship will carry over into the successful treatment of my patients when I get back to work next week and for years to come.

Mahalo!

Today’s guest post was written by Seattle-area tea lover Brett Boynton. Brett has been selling and serving fine tea in Seattle since 2001. He is an active tea educator and the author of Black Dragon Tea Bar blog. You can visit Brett and his friend Cinnabar’s teashop, Phoenix Tea, at 902 SW 152nd St in Burien, WA, or visit their online store.

Puer tea (普洱茶), from Yunnan (雲南) province in southern China, comes in two forms, raw puer (sometimes called green puer or sheng cha) (生茶) and ripe puer (sometimes called black puer or shu cha) (熟茶). The complex flavors found in a cup of puer tea are the result of many variables, such as where the tea was grown, the quality of the leaf, the manufacturing conditions, and the vintage. The form of the tea (loose leaf or compressed into shapes) does not necessarily indicate quality.

Raw puer is prepared from sun dried green tea leaves and is primarily handmade. The leaves are sometimes sourced from organic or wild tea bushes. Old tea trees, which can be well over 100 years old, are also sometimes used to make very fine teas. After the leaves are processed and sorted, they will be compressed into cakes, bricks or other shapes by heavy molds. Raw puer gets darker, richer and smoother if aged slowly in dry conditions. When a raw puer is approximately 1 to 5 years old it will probably still taste like a fresh herbaceous green tea with varying degrees of sweetness, smokiness, and complexity.

Ripe puer can be purchased loose leaf, or compressed into cakes and bricks. Ripe puer differs from raw tea because it has a pile fermentation step included in its manufacture. This is a carefully controlled process that results in a dark and earthy brew. Young ripe puer (1 to 5 years old) is often not very smooth and may still have a harsh odor left over from fermentation. Loose leaf ripe puer tends to taste fuller and smoother sooner, because it has more leaf surface exposed to air. Compressed teas, on the other hand, will mellow slower, depending on how tightly they were compressed and how thick they are.

Both styles of puer tea will get better with age if they are stored properly (ie. dry, dark and away from any odors). Ripe puers are made to be enjoyed sooner, and thus the vintage does not play as important of a role as it does with raw puer. In fact, some puer experts have written that ripe puers do not improve after reaching a certain point. This is in contrast to raw puer, which seems to get better indefinitely as long as storage conditions remain ideal.

Collecting and aging raw puer cakes is a rewarding hobby for many tea lovers. I, for one, enjoy experiencing the tastes of a tea as it changes over time. I also like to keep a scrapbook of the beautiful wrapping papers used to store the cakes. Puer tea has the wonderful ability to bring people together and help them to relax. It is the ideal brew for many unforgettable tea tastings.

Brewing Tips:
Puer can be prepared as if it were a black tea using Western-style tea brewing parameters to very good effect, but for the best possible flavor it should be brewed gongfu style in a small Chinese vessel, such as a gaiwan (a covered cup) or a yixing clay teapot.

To begin, rinse your teaware with boiling water to clean and preheat it.
If you’re using loose-leaf puer, measure out between one and two teaspoons of dry leaf, if you have a brick or a cake of puer, carefully break off a small chunk roughly the size of a quarter, or if you’re using a mini tuocha, simply remove the paper wrapper because it is already the right amount of tea.
Next, pour water over the tea leaves inside the brewing vessel. I like to use freshly boiled water (about 210º F) for puer tea. Slightly cooler water is fine too and will yield a mellower cup.
Wait a couple seconds, then discard this infusion (this water can be used to rinse your teacups again). This optional rinsing step is called “awakening the leaves.”
After your leaves have been rinsed, take a moment to smell them before pouring hot water over them again. This begins the first steep. It is recommended, when steeping a puer tea for the first time, to start by infusing the leaves for 15 to 60 seconds. Four factors to consider in the length of steep time are: amount of leaf, temperature of water, size of brewing vessel, and personal taste. Ask your tea merchant for their advice when you buy a new puer, and with practice it will become easier to determine.
When time is up, decant all of the tea liquor into a small pitcher to stop the infusion. Now, pour the tea into small cups and relish the unique and wonderful flavor of your creation. You should re-infuse the same leaves many times. Generally speaking, each infusion should be slightly longer than the previous one, but I have found very good results from steeping the second infusion about 10% shorter than the first and the third infusion approximately the same length of time as the first. Then, I will begin to increase the steeping time. As with all things, experimentation and practice is the key.

Many women find that the last few weeks of pregnancy are fraught with a myriad of discomforts. As the baby reaches his or her birth weight many moms find it more difficult to move around and function as they did before. One common complaint at this time is ankle swelling. For some women, it is a mild annoyance that shows up at the end of a busy work day, for others it is more severe. In my own pregnancies my ankles were so swollen that the only shoes I could wear were flip-flops. Thankfully, it was August and the weather warranted the footwear. When women develop swelling in the face and hands it is a more concerning sign, and they should report this to their obstetric care provider. Ankle swelling, however, does not usually cause any harm, but it can be very uncomfortable. In Traditional Chinese Medicine there is a common herbal treatment for the condition that any woman should be able to make at home. As a Westerner, the sound of it may not be very appealing, but it is actually quite good, and it works! In Chinese Medicine terms this formula fortifies the Spleen, disinhibits dampness and scatters swelling.

Li Yu Luo Bo Yin, or Carp and Radish Soup

Ingredients:

1 one-pound Carp (Li Yu), gutted and scaled, head and tail removed (or also skinned if desired)

120g (about one cup) chopped daikon radish (Luo Bo)

 

Directions:

Put the ingredients in a pot and cover with water. Bring to a boil then reduce heat and simmer covered until fish is cooked through. Drink the broth and if desired, eat the carp and radish.

 

 

I have not yet done any posts regarding specific cases in my office but this one stood out to me as a success story that should be shared. It is not uncommon for patients to come to me as a “last resort.” After seeing western doctor after western doctor and getting no results, or being offered a multiple drug regimen with multiple risks and side effects people become frustrated. They want to get better, they think they CAN get better, and they try acupuncture in a “last ditch” effort to get better. These cases are especially exciting to me for two reasons. One, often these are situations in which TCM excels. Whenever someone’s situation is “mysterious” or unresponsive to western medicine, it is often quite responsive to acupuncture and herbs. Two, when they get better, they are so thankful and it warms my heart to know that they have been helped after so much time feeling desperate and frustrated. It is particularly satisfying when they report back to their western physician that they have indeed gotten better with this medicine. It plants a seed in that physicians head that maybe there is something to this Asian medicine.

So, back this case I want to share.

A 27 year old man came to me 2 months ago with a five year history of urinary frequency, small bladder capacity and pain. His bladder could not hold the normal amount of urine and when it became “full” he would have severe, sharp lower abdominal pain that could only be resolved by urinating. He woke 3 to 4 times a night to pee, and had trouble falling asleep due to lower abdominal discomfort. He had been through every western bladder/kidney/prostate test available including a very invasive Cystoscopy. He had been to three different Urologists, none of whom could offer him a diagnosis or a treatment plan. The last of which prescribed him antidepressants. Now, side note, this happens ALL THE TIME. My patient was not the least bit depressed. He had some anxiety around the urination issue, but nothing outside of what would be considered normal considering the intensity of the pain and the lack of diagnosis. I have seen this so often I am no longer surprised when it happens. When western medicine cannot find the cause of a physical problem, patients are given antidepressants. Maybe this was all “in his head”, but this man decided he did not want to take drugs that he didn’t think he needed and sought out alternatives.

During his initial visit I discovered that the man had lower back pain as a result of an injury in which he was run over (!) by an ATV when he was 7 years old. He did not require surgery but several of his lower lumbar vertebrae were permanently damaged. This piece of information would mean nothing to a urologist but it meant a lot to this TCM doctor. In addition to back pain he suffered from knee pain that he chalked up to “getting older” at his mere 27 years. His urine was usually clear, although occasionally cloudy and was slow to come out. His hands and particularly his feet, were always cold. He was always thirsty, for room temperature water, but he was afraid to drink because of the bladder problem. He felt fatigued all the time which he didn’t feel was caused by the night waking.

Urinary frequency can be the result of several different TCM patterns. In this case all signs pointed to one thing: Kidney yang vacuity with blood stasis in the bladder. I was fortunate that his symptoms painted such a clear picture, as this isn’t always the case with such chronic conditions. I believed that the Kidney vacuity was primary, and had existed since that terrible childhood accident, if not before, and the blood stasis was a result of the bladder not functioning well for so long. (Chronic conditions often develop blood stasis over time.)

Treatment was simple. We were to start with acupuncture and moxibustion weekly and would add herbs if we didn’t see results in 6 visits. For you TCM geeks out there I used a combination of BL23, 28, Du4, Ki7, Sp8, Ht7, Ren2, 4, 6, and Ki11 over the course of 6 sessions. I applied moxa to the points on the low back and lower abdomen. The results have been great with progressive improvement after each treamtment. After the first couple of visits he noticed a reduction in the number of times he woke at night to pee. After the 5th he noticed a reduction in daytime frequency and a big reduction in anxiety. After the 6th visit he reported he was peeing around 5 times a day (as opposed to hourly) and he was only waking once a night to urinate with a big reduction in fatigue. Although we have reached our 6 visit goal we have determined that more treatment will be necessary as it would be best if he were not waking at all at night. We will continue weekly treatment until we accomplish that and if it hasn’t been accomplished in 3 more visits we will add a granular herbal formula. For the TCM geeks: Jin Gui Shen Qi Wan + Lian Zi, Fu Pen Zi, Tu Si Zi, Suan Zao Ren, Yuan Zhi

In addition to the physical improvement mentioned above, one of the things that stands out to me when I think about this patient is how much his affect has changed in the two months I’ve known him. The first few visits he was somewhat “tightly wound” so to speak. He was visibly uncomfortable, a little defeated in his tone, and all around frustrated. Now when he comes in he is downright cheerful and bright. I hope that he continues to improve and that he can get on with being a normal healthy 27 year old with a life that does not revolve around having a bathroom nearby.

 

 

 

I have many fertility patients who are using fertility predictor kits to track when they are likely ovulating. I find these kits, which require a woman to pee on a stick every day for many days, to be less accurate, more expensive and more inconvenient than good old fashioned BBT charts. A BBT chart tracks a woman’s Basal Body Temperature (the temperature upon first waking in the morning) and also the consistency of her cervical fluid. It allows for additional information, such as illness, insomnia, intercourse, whatever the woman wants to add. Using the chart instead of the kit, a woman learns to understand her own body, her potential fertile time, and gives her the power to determine when she is most likely to conceive. The kit, on the other hand, takes that power away from a woman’s own eyes and mind and provides information from outside of herself that is less accurate, and tells a woman nothing about her overall menstrual health.

As a TCM provider, I can also add the BBT chart to my diagnostic tools for a fertility patient.  For instance, a chart that shows a very slow-rising temperature in the luteal (post-ovulation) phase is possibly indicative of a yang or qi deficiency. Yang (which is warm) is needed for the act of ovulation and for the corpus luteum (the follicle from which the egg was released) to provide enough progesterone for conception and implantation to occur. I do not use the BBT as a sole means of diagnosis, but I do add it to my assessment.

Taking the BBT is simple, but there are some key factors to be aware of. Using a regular thermometer, a woman should take her oral (by mouth) temperature first thing upon waking from at least 5 hours of sleep. If the woman gets up, or even spends time awake in bed before taking her temperature, it will not be accurate as our temperatures do rise with activity. To be most accurate the temp should be taken after 5 hours of uninterrupted sleep, so if a woman goes to sleep at midnight, and wakes at 5am to pee, she should take her temp at 5am before getting out of bed, and not wait until she has gone back to sleep and gotten up at 7am. The number can be recorded on a piece of paper kept by the bed and then transferred to a paper BBT chart at a later time.

Even easier for some, online software can be used in which the number is simply recorded into the application, and the software creates the BBT chart based on the data provided. A nice example of this kind of software is Kindara. I prefer this one to others, as it is easy to use, is pleasing to the eye, and it does NOT try and “predict” when a woman is ovulating. Instead, it helps a woman see for herself just by looking at the chart when she is most likely ovulating. This software can be used on a computer, or on an Iphone and can also be shared online with a fertility doctor or TCM fertility specialist (or a partner!) if the woman chooses.

Cervical fluid is possibly an even more important predictor of fertility than temperature. When a woman is about to ovulate, the fluid changes in structure from a mass of crystals aimed in every which way, to straight tubes that provide a sort of “highway” for the sperm to move up through the cervix and into the uterus, hopefully to the uterine tubes where conception is most likely to occur. When the fluid is structurally tube-like, it takes on a stretchy quality that can be easily pulled/stretched between a woman’s fingers. Learning to assess when a woman’s fluid is most stretchy gives her the knowledge that she is now about to ovulate, even before the temperature rises. The 48 hours BEFORE ovulation are the best days to have sex if a woman is trying to conceive. BBT charts, including the software on Kindara, provide a place to indicate what the cervical fluid is like each day of a woman’s cycle.

My patients that have made the switch from the “pee sticks” to BBT charting all have a renewed sense of control over their fertility potential. They are more confident and feel a sense of pride about their bodies. In my experience, this is the BEST possible way to enter pregnancy and allows a woman to feel that she understand her body and later, she is generally more comfortable making decisions for her body, such as how she wants to deliver her baby.

Understanding our fertility is our right as women, and I honestly believe that charting our cycles during our fertile years is empowering.

Many of my readers are very familiar with the work that doulas do, some of them are doulas themselves. For those of you who are not familiar, I wanted to say a few things about the role of the doula. Before the advent of technological, hospital birthing, women gave birth at home. They weren’t expected to do this alone, they were typically attended by many women, usually family members, and also a midwife. A woman’s mother, sisters, aunts, grandmother, would all assist the birthing woman in whatever way was needed. Providing emotional support and encouragement, offering water and food, gathering wet washclothes, just being there. As birthing moved into hospitals that role moved to the attending nurse, and family members were not present, including the woman’s partner. Eventually, the husband was allowed to be there for the birth of his child, but as technology advanced, the role of the nurse moved more towared monitoring the machines attached the the laboring mother, and away from a supportive role.

The need for female, non-medical support during labor needed to be filled. The doula is a woman (typically, although there may be a male doula out there that I have yet to meet) who is committed to filling that role. She is a person trained in normal labor progress, as well as the interventions that may or may not be required during the course of labor and delivery. She typically knows the risks and benefits of medical intervention as well as having a “bag of tricks” for helping a labor proceed as best as possible. During a woman’s labor she is able to offer support, encouragement, suggestions for different positions or techniques when labor stalls, or becomes rather difficult, or the laboring woman is feeling discouraged or fearful. The doula also acts as an advocate for the woman, helping her understand any medical interventions that are being offered, and any risks associated with accepting or denying those interventions.

During my own labor with my first daughter, my doula (Jennifer Hampton Head, now a midwife in Oregon) was vital. She came to my home when I felt I needed some support during early labor. She helped me to stay focused on the task and when I became scared of the pain and overwhelmed by the seemingly endless process, she took my hands, and looked me in the eye in a way that told me it was all going to be just fine. She rode with me through my entire labor, and later in the hospital, when medical intervention did become necessary, she helped my husband and I understand our options clearly. All of the decisions we made were well-informed because of her. Even the ultimate decision to have my daughter enter this world via cesarean was made from a place of empowerment, not defeat, because of the amazing support of my doula. My midwife was very instrumental in that as well, and I was fortunate that my doula was allowed to be with us during the c-section. Even more atypical, my midwife was given the honor of bringing my very poorly positioned daughter out of me, thanks to a wonderful Obstetrician. Because of the incredible work my doula did, I know that my cesarean was not one of those unnecessary surgical births, but rather the only option left after attempting every concievable option.

During my second labor, my doula was instrumental in my ability to have an unmedicated vaginal delivery. Her awe at my progress gave me faith in myself to continue, and her whispers of “this is normal, this is what it’s supposed to be like” in my ear during transition got me through. Her suggestions for better pushing positions allowed me to push my daughter out in 30 minutes. Two very contrasting labors and births, but in both instances, a doula was extremely important in both progress of the labors, and also in my perception of myself and my ability to give birth.

Doula’s fill a very important role whether women are birthing in a hospital, in a birth center, or at home. There are plenty of statistics available on the lowered intervention rate when doula’s are present. There are even statistics on shorter labors when a doula is present. Right now I want to put statistics aside and just honor what doula’s are. They are women who are passionate about helping women during quite possibly, the more transformative moment of her life, when she becomes a mother, or a mother again. They are women who understand that a woman’s view of herself and her world will be altered in some way during that process, and they are committed to having that alteration be positive. What we experience during our labors can shape how we feel for the rest of our lives. Doulas know that society as a whole is more healthy when women feel supported during their births and they are there to do it tirelessly.

Thank you to all the doula’s out there. Your work is important and I honor it. May every woman be given the opportunity to birth with a doula.

To learn more:

www.dona.org

www.palsdoulas.org

www.openarmsps.org

 

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Chinese dietary therapy often recommends that people limit or eliminate dairy products from their diet. In Traditional Chinese Medicine, dairy is considered a cold food that leads to damp accumulation, particularly in people who have a weakness in their Spleen energy. Symptoms of dampness include lethargy, loose stools, feelings of heaviness, cloudy thinking, excess sputum(particularly in the sinuses), certain types of headaches, and accumulations such as cysts and tumors. The concern for some who want to follow this dietary advice, is whether they will be able to get adequate amounts of calcium from a dairy-free diet. This is certainly a concern as most adults require around 1,000 mg of calcium a day to maintain bone, muscular, vascular and hormonal health. There is disagreement about the exact quantities of calcium in foods, but if a person were avoiding milk, increasing the amounts of the following foods should provide enough calcium for most individuals.

Nuts and Seeds

Sesame seeds (most sources list the calcium content of 1 oz of these to contain more calcium than one 8oz glass of milk)

Sunflower seeds (also high in iron)

Almonds

Soybeans

Brazilnuts

Pecans

Sesame tahini

Legumes

Beans (garbonzo, pinto, soy, canellini)

Tofu (especially calcium-treated)

Dark Leafy Greens

kale

collards

turnip greens

dandelion greens

mustard greens

arugula

chard

chicory (curly endive)

Vegetables

Broccoli

Bok Choy

Acorn squash

Fruit

Figs, dried

Orange juice, calcium-fortified

Kiwi

Grains

Cereal (calcium-fortified)

Amaranth

Brown rice

Oatmeal

Corn tortillas

Fish and Seafood

Oysters, raw

Salmon (canned with bones)

Sardines (canned with bones)

Mackerel

Other

Blackstrap Molasses (also high in iron)

Greek yogurt (although dairy, this is not considered a damp-producing food)

 

 

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I have a fertility-turned-obstetric patient who just emailed me to cancel her appointment for this morning. She was in labor and wouldn’t be needing an induction treatment as we had planned. This is someone who had faithfully come in for treatment throughout her pregnancy, and to whom we applied pre-birth acupuncture from week 36 on. She went into labor 5 days after her due date.

This is typical of primigravidas (first time moms). Having pre-birth acupuncture most typically results in babies that come during the 40th-41st weeks. Rarely do I see those who come in weekly for this treatment get to week 42. The protocol is simple, and the hour spent in session gives the mom some much needed self-care time. Not only is the pre-birth acupuncture helpful for getting labor going in due time, but it has also been shown to reduce the overall time in early labor by an average of 2 hours. 2 hours might not sound like a lot, but believe me, to a woman in labor it is significant. In addition, there is strong anecdotal evidence that women who receive pre-birth acupuncture require less medical intervention during labor than women who do not. I encourage all of my obstetric patients to come in once a week from week 36 to week 41. Once we pass week 41, we can apply a stronger induction-style treatment 3 times in a week as these moms may be facing a decision to medically induce with Pitocin should they reach week 42. I do not actively induce moms before their due dates, and I find that those who receive pre-birth treatment rarely require it.

For acupuncturists interested in incorporating the pre-birth protocol into their obstetric practice, I use the following points as a base of treatment, and add any points that I feel will benefit the particular patient depending on other symptoms present and using a differential diagnosis.

Weesk 36-38: (using no stimulation) GB34, ST36, Sp6 (if there is a history of rapid uncontrolled labor, substitue with Ki8), Bl62, yin tang. If the baby’s position is not optimal, add Bl67 and Bl60

Weeks 38-40: (using no stimulation) GB34, St36, Sp6, Bl62 (again, add Bl67 and Bl60 if needed), yin tang, GB21

Week 41: (using strong stimulation) GB34, St36, Sp6, Bl62 Bl60,, Bl67, yin tang, GB21, LI4 Bl31, Bl32

These points can all be needled bilaterally in a seated position, or unilaterally in a side-lying position. I favor side-lying as many moms become quite relaxed and meditative.

 

 

 

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At the farmer’s market this weekend I came across this year’s first batch of Stinging Nettles, or Urtica dioica. Nettles are one of those plants that remind me how miraculous the planet is. Just when everyone is suffering from allergic rhinitis (stuffy nose) the plant that treats that symptom is ready for harvest. Nettles have many uses, but allergic rhinitis is what they are famous for. In Chinese Medicine we say that Nettles clear heat and leach dampness, making them suitable for treating phlegm-damp obstructing the nasal passages. Dry them and add them to your Chrysanthemum infusion for a great allergy treatment. They should be used with caution, however, in those with a yin deficient presentation, as they are diuretic (make you pee) and can be quite drying. Another use of the herb is Wind-Damp Impediment, such as arthritis, and historically they were applied topically as a counter-irritant for this purpose. Taken internally, they also treat arthritic conditions or painful, stiff joints.

The whole arial parts can also be cooked as a delicious spring vegetable. They have a very high mineral content making them an ideal food for those with anemia or for those concerned about developing osteoporosis. Here is a recipe for sauteed stinging nettles that I found on Chow.com:

  • 1 pound stinging nettles
  • 2 tablespoons olive oil
  • 1 large shallot, sliced lengthwise and thinly sliced
  • 1 teaspoon kosher salt
  • 4 medium garlic cloves, minced
  • 1/2 cup water
  • Zest of 1 medium lemon
  • Juice of 1/2 medium lemon
  • Wearing thick rubber gloves, clean the nettles by soaking them several times under cold running water, then drain. (Do not touch raw nettles with your bare hands. If you do not have rubber gloves, use tongs to handle the nettles.) Separate the tender leaves from the tough stems, discarding the stems. (Use scissors for this process if you don’t have protective rubber gloves.)
  • Heat the oil in a large frying pan over medium heat until shimmering. Add the shallots and salt and cook, stirring occasionally, for about 2 minutes. Add the garlic and cook until the shallots have softened, about 2 minutes more.
  • Using tongs, add half of the nettles and the water to the pan. Cook, stirring often, until the nettles have begun to wilt, about 2 minutes. Add the remaining nettles and cook, stirring often, until wilted, about 3 minutes more. (Add more water a tablespoon at a time if the pan becomes too dry.)
  • Remove the pan from heat. Stir in the lemon zest and juice. Season with salt and freshly ground black pepper and serve.

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A couple of years ago I posted this about Chrysanthemum tea. I wanted to revisit the topic, as I have been seeing so many patients lately suffering from Spring allergies which are causing itchy, watery, sometimes burning eyes. Chrysanthemum is the perfect herb for this symptom. It clears windheat (itching, burning) and enters the Liver channel, directly affecting the eyes which are ruled by the Liver. It is also useful for headaches caused by allergies. To brew a medicinal-strength infusion of the herb, put a handful of the dried flowers in a mug with about 8 oz hot water. Steep, covered, for a minimum of 10 minutes, preferably 15. This tea will be bitter and adding honey is fine. Another option is to infuse a larger pot of the flowers, then let cool and put in the fridge. Enjoy as a cold tea on warm spring days when allergies are in full effect.

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